Provider Demographics
NPI:1639254055
Name:MACE, JENNIE ABIGAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:ABIGAIL
Last Name:MACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4131 NW 13TH STREET
Mailing Address - Street 2:SUITE101
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-1858
Mailing Address - Country:US
Mailing Address - Phone:352-376-1887
Mailing Address - Fax:352-375-7451
Practice Address - Street 1:6500 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4309
Practice Address - Country:US
Practice Address - Phone:352-333-4180
Practice Address - Fax:352-333-4861
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME44184207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00216933OtherRR MEDICARE
FL046330200Medicaid
02827OtherBCBS
FL046330200Medicaid
D33151Medicare UPIN